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  • Therapeutic Phlebotomy Order Form (03-f46) - Stanford Blood Center - Bloodcenter Stanford

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03F46 Special Donations Part of Stanford University School of Medicine. Palo Alto, CA 94304 Therapeutic Phlebotomy Request Ref: 030401 Special Donations Department Tel: (650) 7236667 FAX: (650) 7238155.

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Therapeutic phlebotomy is relatively safe and efficient at depleting iron stores in the body; thus, this procedure is effective for treating patients with hemochromatosis, polycythemia vera, and related conditions.

It is used mainly to reduce blood volume, red cell mass and iron stores. Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary to arterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale.

Phlebotomy should be started by withdrawing 250 to 500 cc of blood daily or every other day until a hematocrit between 0.4 and 0.45 (40% and 45%) is obtained. In the elderly or those with a cardiovascular disease, a smaller amount of blood (200 to 300 cc) should be withdrawn twice weekly.

Patients with a prephlebotomy hemoglobin concentration of less than 11 g/dl are more likely to have symptoms of hypovolemia and anemia. Therapeutic phlebotomy, when hemoglobin levels are less than 11 gm/dl, is less efficient at depleting iron stores in the body.

Instructions After Your Procedure Drink more liquids than usual for 1 to 2 days after your procedure. ... Avoid alcohol and drinks with caffeine (such as coffee, tea, and cola) for the rest of the day after your procedure. Avoid strenuous exercise (such as jogging) for 1 day after your procedure.

Place a hemostat on the needle line. Inflate the blood pressure cuff, perform the venipuncture and secure the needle with tape. Remove hemostat from needle line and allow blood to flow into the transfer pack. A scale may be used to weigh the blood as it is withdrawn.

During a phlebotomy, approximately one pint of blood will be taken from a vein in your arm. The actual process takes approximately 30-45 minutes. After the procedure is completed, it will be necessary for you to rest for 15-20 minutes and drink some juice or water. The entire procedure takes about one hour.

This helps the physician to form an estimate of when the serum ferritin is will be below 1,000ng/mL. For patients whose initial serum ferritin (SF) is greater than 1,000 ng/mL, phlebotomies can be as frequent as twice a week.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232